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The Relationship Between Organisational Stressors and Mental Wellbeing Within Police Officers: a Systematic Review Amrit Purba1 and Evangelia Demou2*

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The Relationship Between Organisational Stressors and Mental Wellbeing Within Police Officers: a Systematic Review Amrit Purba1 and Evangelia Demou2* Purba and Demou BMC Public Health (2019) 19:1286 https://doi.org/10.1186/s12889-019-7609-0 RESEARCH ARTICLE Open Access The relationship between organisational stressors and mental wellbeing within police officers: a systematic review Amrit Purba1 and Evangelia Demou2* Abstract Background: Occupational stressors in police work increase the risk for officer mental health morbidities. Officers’ poor mental wellbeing is harmful to the individual, can affect professionalism, organisational effectiveness, and public safety. While the impact of operational stressors on officers’ mental wellbeing is well documented, no review has systematically investigated organisational stressor impacts. This study aimed to conduct a systematic review to assess the relationship between organisational stressors and police officer mental wellbeing. Methods: Systematic review conducted following PRISMA and Cochrane Collaboration guidelines. Literature search was undertaken from 1990 to May 2017 on four databases (EBSCOHOST Medline/SocINDEX/PsycINFO/OVID Embase) and grey literature. Included articles were critically appraised and assessed for risk of bias. Narrative and evidence syntheses were performed by specific mental health outcomes. Results: In total, 3571 results were returned, and 15 studies met the inclusion criteria. All included studies were published in English between 1995 and 2016, had cross-sectional study designs, spanned across four continents and covered 15,150 officers. Strong evidence of significant associations was identified for organisational stressors and the outcomes of: occupational stress, psychiatric symptoms/psychological distress, emotional exhaustion and personal accomplishment. The organisational stressors most often demonstrating consistently significant associations with mental health outcomes included lack of support, demand, job pressure, administrative/ organisational pressure and long working-hours. Conclusions: This review is the first to systematically examine organisational stressors and mental health in police officers. Organisational stressors that can be targeted by interventions and policy changes to secure officer wellbeing, a healthy work environment, and benefits to the organisation and the public are identified. Keywords: Police, Officer, Mental health, Wellbeing, Organisational stressor Background The police work environment has many occupational Mental wellbeing (MW) in police officers stressors and exposures that can lead to increased risk for Mental health (MH) disorders are a leading cause of long- mental health morbidities [8]. Policing is one of the most term work incapacity and sickness absence [1]. The rise in stressful occupations as maintained by academic re- MH problems over the past decade in the working popu- searchers, police practitioners, health-care professionals and lation has spurred increased public, policy and academic psychologists [9–12] and it ranks in the top three occupa- interest [2–4], leading to a focus of research on the role of tions in the Occupational Disease Intelligence Network work environments and lifestyle behaviours on mental (ODIN) system for Surveillance of Occupational Stress and wellbeing (MW) across occupational groups [5–7]. Mental Illness (SOSMI) [13]. Police officers experience the same combination of MH issues as the general working population [14, 15]; however, their work is compounded by * Correspondence: [email protected] 2MRC/CSO Social and Public Health Sciences Unit, Institute of Health and frequent exposure to inherently dangerous situations, Wellbeing, University of Glasgow, Glasgow G2 3AX, UK which require a different level of physical and mental ability Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Purba and Demou BMC Public Health (2019) 19:1286 Page 2 of 21 to respond effectively [16–18]. While this can predispose the MW outcomes commonly demonstrating or suggested police officers to stress, some research suggests that individ- to be associated with organisational stressors in police of- ual coping mechanisms can become embedded in police of- ficers are occupational stress [48, 49], anxiety [50], depres- ficers personalities, allowing them to cope and accept sion [50, 51], psychiatric symptoms (PS)/psychological stressful situations as natural requirements of their role [19, distress (PD) [51, 52], burnout [51, 53] and suicidal idea- 20] and be more resilient to stress than civilians [5]. Fitness tion [54]. for work is central to professional police standards [21, 22]. Therefore, determining which occupational stressors Rationale are related to specific MW outcomes may improve Understanding the risk factors to mental wellbeing in the police officer wellbeing and contribute to organisa- police workforce is paramount [11, 42, 55], as police play a tional effectiveness [22]. vital role in the maintenance of society. A previous system- atic review [56], assessed coping behaviours adopted by po- Occupational stressors in police work lice but did not focus on associations between occupational Intrinsic to police work is the daily experience of in- stressors and MW. The aim of our review, is to examine tensely stressful situations in often higher frequencies the associations of organisational stressors in police work than most other occupations [23, 24]. Constant exposure with the mental wellbeing outcomes of: occupational stress, to people suffering distress and pain, threats to officer anxiety, depression, psychological distress (PD), psychiatric safety and wellbeing, having to be in control of emotions symptoms (PS), burnout (a composite measure of deper- when provoked, the inconclusive nature of police work, sonalisation (DP), personal accomplishment (PA) and emo- the responsibility of being in possession of a firearm and tional exhaustion (EE)), and suicidal ideation. more importantly the responsibility of protecting the lives of citizens have been recognised as significant Methods sources of stress [25]. These daily activities are con- Aim stantly under scrutiny due to the societal and political Systematically review the literature to assess the relation- expectations put on human-service professions [26]. As ship between organisational stressors and police officer human-service jobs entail a great deal of interaction with mental wellbeing. the public, police officers are often expected to display and/or manage particular feelings as part of their job, considered a form of ‘emotional labour’ [27, 28]. Review methodology Territo and Vetter [29] suggested the stressors affect- The review was carried out systematically following the ing police officers could be grouped into four categories Cochrane Handbook for Systematic Reviews [57] and (organisational practices and characteristics, criminal PRISMA Statement [58] guidance; the narrative synthe- justice system practices and characteristics, public prac- sis followed the Economic and Social Research Council tices and characteristics and police work itself). These (ESRC) guidelines [59, 60]. four categories can be further classified into operational and organisational stressors [30, 31]; the former associated Eligibility criteria with the very nature of police work, including job-related Inclusion criteria were set priori and were based on the violence [32], exposure to danger and facing the unknown Population, Intervention, Comparison and Outcome [32], court overtime [33, 34], and the latter related to or- (PICO) framework [59, 61] (Additional file 2: Table S2). A ganisational administration, management, structure and scoping search was conducted in EMBASE to pre-test the processes [32]. suitability and adequacy of the PICO criteria. Inclusion Organisational stressors have been suggested to be a criteria included: police personnel from various ranks of greater source of stress for police officers [35, 36]because any age or gender, including trainees and recruits; studies officers may recognise them as oppressive [37], unneces- that considered other occupational groups as well as the sary [37], unavoidable [37] and uncontrollable [38, 39]. police were suitable if a separate analysis of the relation- Organisational stressors suggested to contribute to the ship between organisational stressors and police MW manifestation of stress include lack of support, heavy work could be extracted (study population); studies identifying load [32], interpersonal conflict with colleagues and super- one or more organisational stressors in relation to police visors [40], inadequate resources, time pressure, and an MW (exposure); MH outcomes measured by general mea- overly bureaucratic organisational system, punitive of staff sures of wellbeing such as self-reported perceptions of and strictly managed [40, 41]. These findings seem to hold health status, subjective MH, studies considering physio- over cross-cultural comparisons cross the UK [30, 42, 43], logical, organisational
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